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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS ICounty Township Year
°rxy'\ FOR DEDUCTION FROM ASSESSED VALUATION �`+"\y, 1°: ,l State Form 43709(R13/10-15) 1-F,D
Prescribed by Department of Local Government Finance
INSTRUCTIONS: �i File Mark
To be filed in person or by mail. FEB 1G 2.2020 Form filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought.
Must be filed or postmarked with the County Auditor or County Recorder of the county where the roperty is uT❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year. County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County_Audito
where the property is located during the twelve(12)months before March 31 of each ye f c kfnl lei(§,blyh(q U U I I U i
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Zachary P. Frantz and Kameran L. Frantz, h&w
Taxing District Key number!legal description Reco umbel Pp n
Haubstadt 26-18-36-404-000.123-009 G (J-
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year date of application legal or equitable owner?
$147,000.00 p Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant,indicate below: Is the property in question:Annually Assessed
t] Real Property El Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Old National Bank
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
101 Northwest Fourth, Evansville, IN 47708
Name of assignee or other owner or holder of mortgage 1 2 Z, C. p
Address of assignee(number and street,city,state,and ZIP code) n'' ' "/yl e 1✓" L.
Does applicant own property in any If yes,what county? What Taxing District? h' I'1I t 1 Il/t ""IJ deduction
other county o
in Indiana? ❑Yes ✓ No Oi person is not entitled to this deduction unless the person has a balance on the person''s 1, /_ i;i-
A01) I the county
recorder's office(including any home equity line of credit that is recorded in the county rec,
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signatur of County Auditor . County Date(month,day,year)
I/We certify under the penalty of perjury that t e abov nd foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Signature(owner's full name) Date(month,day,year)
02/06/2020
Full resident address of applica (number and street city,state,and ZIP code)
101 S Haven Dr., Haubstadt, IN 47639
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street,city,state,and ZIP code)